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Inspection on 06/10/09 for St Benedict`s Nursing Home

Also see our care home review for St Benedict`s Nursing Home for more information

This inspection was carried out on 6th October 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff are committed to providing good personal care for the residents. We saw that residents are well groomed, and appropriately dressed for the time of year. There are good processes in place for staff recruitment, with all required checks carried out prior to confirmation of employment.

What has improved since the last inspection?

Documentation has been improved since the last inspection. This includes amending the statement of purpose, the service users’ guide, and the complaints procedure. Improvement was evidenced in regards to care planning since the last inspection. Care plans are reviewed monthly, and residents or relatives are involved in the process where possible. They include risk assessments, and plans for delivering all aspects of care. The format has been changed, and the plans are still in the process of being re-written and updated. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 The activities programme has been extended by a few hours. The menus have been discussed with the residents, and have been revised. The quality of the food has been improved, and includes more home cooked meals, and more fresh fruit and vegetables. The manager has set up a maintenance folder which includes ongoing checks for how well bed rails are fitted; recording of hot water temperatures; wheelchair checks; call bell system checks; and fire safety checks. Staffing levels have been raised, so that there are more care staff on duty in the afternoons, evenings and night times. There are increased hours for kitchen and domestic staff. The manager has implemented quality assurance procedures, including residents and relatives meetings, staff meetings, and questionnaires. This provides residents and relatives with increased opportunity for raising any concerns. The manager has implemented one to one formal supervision for individual staff members. The manager has instigated new policies and procedures for the home. These still need to be revised to make them personal to this home, but cover the basic policies and procedures which should be in place.

What the care home could do better:

The providers have failed to meet requirements for health and safety, in that: there are two bedrooms with frayed carpets which pose a risk of tripping. And the patio at the rear of the property has not been attended to, and the uneven slabs pose a risk of tripping. Residents do not currently go out unaccompanied. The providers have failed to complete an improvement plan with timescales showing how they intend to refurbish the building; and there is no evidence to show that refurbishment has been commenced. The providers have failed to clean or replace dirty and stained carpets. The providers have failed to ensure that there are sufficient bathrooms which are suitable for the residents’ use. The providers have failed to review the standard of furniture and replace all damaged units, old armchairs, and tables.St Benedict`s Nursing HomeDS0000026118.V377977.R01.S.docVersion 5.2The providers have not informed the Commission of any reason why they could not carry out the requirements given at the last inspection. We will be asking the providers to confirm their financial viability for running this home. The clinical room has been extended, but the old flooring has been left in situ. This includes an area of old and stained carpet, which is not good for infection control. There is no pedal bin in the clinical room, and this does not promote good infection control. The activities hours have been extended by half a day, to three and a half days per week. These hours are insufficient to provide residents with the opportunity to carry out the activities of their choice. The manager has been in post for four months but has not applied to the Commission for registration. There is no hot water urn in the kitchen, and this equipment is needed to keep up with the provision of hot drinks for residents. There is a damaged bathroom door on the ground floor which needs replacing.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing Home 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Lead Inspector Mrs Susan Hall Key Unannounced Inspection 6th October 2009 09:00 DS0000026118.V377977.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Benedict`s Nursing Home Address 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 362398 Macari Homes Ltd Manager post vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (0) of places St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 25. Date of last inspection 18th May 2009 Brief Description of the Service: St Benedicts Nursing Home is situated in a residential area of Herne Bay overlooking the sea, and is close to local amenities including local pubs, shops and churches. It is owned by Macari Homes Limited, and since 31st July 2008, has two new Directors. The Responsible Individual, Mrs. R. Persand takes an active role in overseeing the service. The building is a large detached house, which has been extended and converted. There is a car park at the rear of the building, accessed from the front by a driveway to one side of the building; and this can accommodate up to eight vehicles. There is also car parking available on the road at the front. Accommodation is provided on two floors, with a passenger lift between floors. Most bedrooms are for single use, and some have en-suite facilities. The home has a lounge and adjacent dining room at the front, and a small lounge at the rear. This leads into a conservatory, and into a paved patio area in the garden. Access to the garden is facilitated via a ramp. There is wheelchair access to most areas in the home. Each bedroom is fitted with a call bell and a TV point. The home offers mainly nursing care but residents requiring residential care can be accommodated. Weekly fee levels are set according to local authority funding; and up to St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 5 £625.00 per week for privately funded residents. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of Adequate, 1 star. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it had been well completed by the manager. We did not send out any survey forms for this inspection visit, but viewed the home’s own quality assurance procedures. The inspection visit took place over eight hours, commencing at 09:00a.m, and finishing at 5.15p.m. The manager was present in the home until 4.15p.m; and the registered provider visited the home for approximately one hour during the morning. We carried out a key inspection on 15th and 16th April 2009, and rated the home as poor at that inspection. Since then, the Commission has been carrying out enforcement action. This includes the following: we carried out a pharmacy inspection on 18th May 2009, and some additional requirements were given as a result of that inspection. We have issued two Statutory Notices, in respect of regulations that were not met for health and safety; care planning; and staffing (Notice 1); and also for medication (Notice 2). During June 2009, we issued a Notice of Proposal to impose a condition, for there to be “no further admissions of service users to the home without the prior written agreement of the Commission”. The provider did not dispute this proposal, and the Notice imposing the condition was issued during July. A manager was appointed during June 2009, but was not registered with the Commission, and has not applied for registration. This is one of the requirements in the Notice. We have carried out a compliance visit (a random inspection) on 2nd July, and a pharmacy compliance visit on 13th July. Two safeguarding adult alerts were raised prior to the key inspection of 15th and 16th April 2009, and five more alerts were raised after that inspection visit. We have followed the agreed protocols with Social Services in sharing St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 7 information, and we have taken part in safeguarding meetings which have been held during this time. The alerts have now been closed, but Social Services have put a “flag” on the home that they will not put forward any new residents for admission until such time as we remove the notice imposing a condition. We will continue to work in accordance with our agreed protocols. During the compliance visits, we assessed the outcome of immediate requirements which had been issued, and did not inspect all other requirements given at the key inspection in April 2009. However, at this visit, we assessed all of the requirements given during the key inspection 15th and 16th April, and the requirements from the pharmacy inspection on 18th May. We found evidence that the manager is implementing improvements within her remit, but as she is not registered with the Commission, it is the providers’ responsibility to ensure that the necessary action is taken to meet all of the requirements. During this inspection we talked with nine staff, (some at length, and some briefly); and talked with three residents; and met several other residents and one relative briefly. We viewed documentation including care plans, the complaints procedure, medication charts, some policies and procedures, activities records, maintenance files, and staffing records. We viewed all communal areas and bathrooms; and twelve bedrooms. What the service does well: The staff are committed to providing good personal care for the residents. We saw that residents are well groomed, and appropriately dressed for the time of year. There are good processes in place for staff recruitment, with all required checks carried out prior to confirmation of employment. What has improved since the last inspection? Documentation has been improved since the last inspection. This includes amending the statement of purpose, the service users’ guide, and the complaints procedure. Improvement was evidenced in regards to care planning since the last inspection. Care plans are reviewed monthly, and residents or relatives are involved in the process where possible. They include risk assessments, and plans for delivering all aspects of care. The format has been changed, and the plans are still in the process of being re-written and updated. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 8 The activities programme has been extended by a few hours. The menus have been discussed with the residents, and have been revised. The quality of the food has been improved, and includes more home cooked meals, and more fresh fruit and vegetables. The manager has set up a maintenance folder which includes ongoing checks for how well bed rails are fitted; recording of hot water temperatures; wheelchair checks; call bell system checks; and fire safety checks. Staffing levels have been raised, so that there are more care staff on duty in the afternoons, evenings and night times. There are increased hours for kitchen and domestic staff. The manager has implemented quality assurance procedures, including residents and relatives meetings, staff meetings, and questionnaires. This provides residents and relatives with increased opportunity for raising any concerns. The manager has implemented one to one formal supervision for individual staff members. The manager has instigated new policies and procedures for the home. These still need to be revised to make them personal to this home, but cover the basic policies and procedures which should be in place. What they could do better: The providers have failed to meet requirements for health and safety, in that: there are two bedrooms with frayed carpets which pose a risk of tripping. And the patio at the rear of the property has not been attended to, and the uneven slabs pose a risk of tripping. Residents do not currently go out unaccompanied. The providers have failed to complete an improvement plan with timescales showing how they intend to refurbish the building; and there is no evidence to show that refurbishment has been commenced. The providers have failed to clean or replace dirty and stained carpets. The providers have failed to ensure that there are sufficient bathrooms which are suitable for the residents’ use. The providers have failed to review the standard of furniture and replace all damaged units, old armchairs, and tables. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.2 Page 9 The providers have not informed the Commission of any reason why they could not carry out the requirements given at the last inspection. We will be asking the providers to confirm their financial viability for running this home. The clinical room has been extended, but the old flooring has been left in situ. This includes an area of old and stained carpet, which is not good for infection control. There is no pedal bin in the clinical room, and this does not promote good infection control. The activities hours have been extended by half a day, to three and a half days per week. These hours are insufficient to provide residents with the opportunity to carry out the activities of their choice. The manager has been in post for four months but has not applied to the Commission for registration. There is no hot water urn in the kitchen, and this equipment is needed to keep up with the provision of hot drinks for residents. There is a damaged bathroom door on the ground floor which needs replacing. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 (standard 6 is not applicable in this home). People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose and the service users’ guide have been revised to include all relevant information. EVIDENCE: The statement of purpose and service users’ guide have been re-written since the last key inspection visit. The statement of purpose includes details of the registered providers and of the manager. It includes information about items such as the pre-admission process, care planning, visiting arrangements, activities, arrangements for leaving the home, and what is included and not included in the fees. (For example, newspapers, dry cleaning, hairdressing and chiropody are not included). The document states that the home has a diversity policy in which they are committed to ensuring that no one is St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 12 excluded on the grounds of their ethnicity, religion or culture. The complaints procedure is included. The service users’ guide contains the same information as the statement of purpose, but is produced in larger print. The manager said that she is in the process of ensuring that each resident has an up to date copy in their room. The manager has implemented a pre-admission assessment format, which would include all required information. However, as the home is currently not permitted to accept admissions, we were unable to see a completed format, and cannot therefore verify how well pre-admission assessments would be carried out in practice. New residents would be admitted for a trial period of four weeks, with a review at the end of this time. Residents (or their authorised representative) are provided with a contract which includes the terms and conditions of residency. We did not view any contracts at this visit. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and care staff are showing a commitment to delivering care according to individual preferences. Care plans are still being upgraded, but demonstrate better risk assessments and wound care. Medication management is improved, but the clinical room floor is unsatisfactory. EVIDENCE: After the last key inspection, we visited the home for a pharmacy inspection on 18th May; a compliance visit on 2nd July; and another compliance visit for pharmacy requirements on 13th July. At the first compliance visit we viewed all care plans for moving and handling assessments; care plan reviews; prevention of pressure sores; and bed rail risk assessments and consent. We also checked each set of bed rails with the nurse on duty, and viewed all pressure-relieving equipment in use. We found St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 14 that all moving and handling assessments had been satisfactorily completed; care plan reviews had been commenced; and bed rail risk assessments and consent were in place. However, we found that all but two of the bed rails were not properly fitted, causing a risk of entrapment. The other two sets were also loose, but were slightly better fitted. We brought this to the attention of the providers. We were informed that the maintenance man was working to ensure that the bed rails fitted the beds correctly. The registered provider also said that she would contact the manufacturers, as many of the bed rails were newly purchased. Since then, weekly checks have been implemented, and we viewed these records, and also viewed several sets of bed rails at random. One set had a substantial gap between the mattress and the bed rail. The manager said that she would implement immediate procedures to change the bed or mattress or bed rails, to provide a safe environment for the resident, and asked the maintenance man to deal with this. We have not issued a requirement for this, as we are confident that this matter was being dealt with immediately. The manager is in the process of implementing a revised care plan format, and has updated eleven out of fifteen care plans to date. We viewed three care plans at this visit. These are now set out in indexed files, which makes it easier to access the information. The care plan files include detailed assessments which include a moving and handling assessment, pain assessment, dependency levels, maintaining a safe environment, prevention of falls, communication assessment, nutritional risk assessment, continence assessment, and a mental capacity assessment. The risk assessments we viewed were properly completed, showing the action to be taken to prevent risks. We viewed a bed rail assessment which included the consent of the resident. Care plans are put in place in relation to the outcomes of the assessments, and are reviewed monthly. We noted that care plans now include evidence that people’s individual preferences are taken into account, with information including people’s preferred times for getting up and going to bed, and how often they would like a bath (there is no shower available). Night care plans are particularly detailed, and include information such as “X has four pillows and likes to sleep sitting upright”. The manager is ensuring that each resident has a mental capacity assessment, to show if they are able to make decisions for themselves. These show if the person has limited ability, such as choosing their clothes or food, but may no longer be able to cope with complicated information and accompanying decisions. The forms then show how decisions will be made on behalf of the person, and in their best interests. We noted at the visit in July that nutritional assessments were much improved. Care plans include monthly weight monitoring, and indicate if the person has a special diet e.g. diabetic or liquidised diet. One of the care plans shows that a St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 15 referral was made for a dietician to visit the resident. There is also evidence of input from other heath professionals including a referral to a physiotherapist, and input from the palliative care team. The manager stated that there were no residents with pressure sores. One resident has needed ongoing wound care, and we viewed this documentation. This was substantially improved from previous wound care documentation. Each wound is assessed individually, and there is a record of each dressing change, and a separate record of the state of the wound and the healing progress. Photographs are taken at regular intervals to demonstrate this. A daily record is maintained for each resident. Nursing records were seen to be dated and signed, but did not include the time of entry. The manager said she would ensure this is rectified with immediate effect. The records do not contain much information, and phrases such as “good day” and “comfortable night” convey little information. The manager said that she was already discussing this with nursing staff, and expecting improvements with this documentation. We issued some requirements in regards to medication at the last key inspection, and the pharmacy inspector issued further requirements at her visit. When she returned to check compliance, there were still two issues outstanding. One of these was that the controlled drugs cupboard was not properly affixed to a solid wall. We checked this at this visit, and found that this has now been done. The other issue was that there were gaps on the recording of the Medication Administration Records (MAR charts). We viewed all of the MAR charts at this visit, and there were no gaps. Medication is mostly administered via a monitored dosage system. Storage has been improved since the last key inspection, as the clinical room has been extended, and some additional cupboards have been fitted. The stock cupboard was seen to be in good order, with no overstocking, and no items out of date. External creams are stored separately from internal medication. Bottles of medicines and eye drops are dated on opening. The drugs fridge temperature and the room temperature are checked daily, and the records showed that these are now satisfactory. There are clear guidelines in place for “as necessary” medication. There are no homely remedies kept on site, and no residents are self-medicating. The manager has implemented weekly checks for auditing the controlled drugs. Medication policies and procedures have been revised and are available for all nurses to view. Where the clinical room has been extended, the old flooring has been left in situ in both areas. This includes some old, dirty carpeting on half of the floor. The floor cannot be properly cleaned, and this is poor management of infection control. Also, the bin for disposing of paper towels after hand washing is not a pedal bin, and this does not promote good infection control. There is a requirement to replace the flooring in the clinical room so that it can be properly cleaned and maintained. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 16 Care staff were observed as being careful to maintain residents’ privacy and dignity, in regards to giving personal care, hoisting in the lounge, and with toileting. One resident said that “the staff are very good to me”. Care plans show that end of life care is discussed where possible with residents or their relatives, as applicable. The manager has obtained additional advice and support from the palliative care team when needed. Additional training in palliative care is being made available for some staff. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient activity hours are provided to enable residents to have their choice of activities throughout the week. Food management and menu choices have been improved. EVIDENCE: An activities co-ordinator works in the home for three days per week, and there are two other staff who carry out activities; one for two hours, and one for one afternoon per week. There is a weekly activities diary in place, and this is displayed in the dining room. The activities co-ordinator is very motivated, and is taking time to find out residents’ preferences for activities, and how to meet these. She is setting up activity-related records for each person, showing details of things such as special events in their lives; important dates, beliefs, hobbies and interests. This helps to create a holistic view of the whole person. There are some group activities such as music and singing, quizzes, games and watching DVDs; and one to one activities such as choosing library books, craft activities, reminiscing, and going out for walks. Most residents are St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 18 wheelchair users, and two said how much they appreciate being taken out for walks on the seafront. The activities co-ordinator arranged for a summer fete, with the help of other staff, and some of the relatives. This has encouraged the residents to decide to have a Christmas Bazaar as well, and a committee has been formed, which includes two of the residents. This sort of activity is providing an opportunity for greater links with the community. Visitors are welcomed at any time, so long as this is the resident’s wish. Residents are enabled to pursue their beliefs, and weekly Christian church services are made available in the home for anyone who wishes to attend. The manager will also arrange for ministers from other faiths to visit the home if requested to do so. Menus have been revised by the manager after discussion with the residents, and there is currently a four-weekly menu plan in place. This provides a satisfactory variety of food for good nutrition. The manager said that the menus would be reviewed with the cooks, to see if changes need to be made e.g. if there are some dishes which residents do not want. Menus reflect better choices than previously. The cooks make home-made soups, and home-made cakes on most days. There is a now a kitchen assistant on duty each day to assist the cook, and a supper cook for evening. This is an improvement since the last key inspection. Residents said that there have been some improvements with the food, and this is partly due to using better quality ingredients instead of tinned “value” foods from a local supermarket. The meat is obtained from a butchers’ shop; and there has been an increase in the use of fresh fruit and vegetables. The hot water urn in the kitchen has broken and has not been replaced. The kitchen staff are using two kettles for boiling hot water, but these are insufficient to keep up with supplying hot drinks for residents, and for using hot water for cooking purposes. The kitchen was found to be unsatisfactory at the last inspection, with dirty storage cupboards for food; and old cupboards for storing crockery items. The old food storage cupboards have now been removed, and a new food storage cupboard has been created in a nearby area. There are daily and weekly cleaning schedules in place. We contacted the Environmental Health Department on the second day of the last inspection, with a request that an officer would visit and make a full assessment. An Environmental Health Officer visited the home in May 2009 and made several requirements and recommendations. We expect the providers to comply with their requirements. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure has been updated, and residents have been informed of this. All staff have been trained in the protection of vulnerable adults. EVIDENCE: The complaints procedure has been amended, and now includes all of the required data. It is displayed in the entrance hall, and is included in the services users’ guide, so that it is accessible to residents and visitors. The procedure states that there will be an acknowledgement of complaints within twenty-four hours; a response to written complaints within seven days; and a full investigation and response within twenty-eight days. The procedure includes the contact details for the manager, the local Social Services department, and for the Care Quality Commission. All residents and relatives have been informed of the amended complaints procedure. The manager has implemented a complaints log to monitor complaints, and this is reviewed each month. No complaints have been received since the last inspection. Staff are trained in the recognition and prevention of adult abuse, and this is supported by a whistle-blowing policy. The staff training matrix confirms that St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 20 all staff have had this training. Staff recruitment procedures are well managed, with POVA First and Criminal Record Bureau (CRB) checks prior to employment. The home has had seven Safeguarding alerts opened during the last eight months. These were investigated by the Social Services Safeguarding Adults team, and were substantiated. All of these alerts have now been closed. We have been involved in the safeguarding meetings, and have informed the team of the enforcement proceedings which we have been taking, in line with agreed protocols and information sharing. We have imposed a condition for no admissions, until such time as we are confident that the providers are meeting all requirements, register a manager with the Care Quality Commission, and can show sustained improvements for residents. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,22, 24,25,26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has taken action to instigate ongoing maintenance checks. The providers have failed to meet requirements given in regards to the environment, and health and safety issues. EVIDENCE: The last key inspection raised many concerns about the general condition of the premises, both internally and externally; the levels of cleanliness; and health and safety concerns. We visited the home again in July 2009, (a “compliance” visit), to check that immediate requirements had been met. This included checks for trailing leads and properly fitted bed rails; the use of hoisting facilities and slings and other moving and handling equipment; and fire safety. We contacted the fire officer on the second day of the last key St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 22 inspection, as there were door wedges holding open most bedroom doors. This compromised fire safety. When we visited the home in July, we found that all bedroom doors have been fitted with “dorguard” safety fixtures, which ensure that doors will close when the fire alarm sounds. We viewed maintenance records at this visit, which confirm that there are weekly checks to ensure that these fixtures are working correctly. The compliance visit also confirmed that hoists and slings were in working order. New slings have been purchased which are appropriate for use by the residents. There were no trailing leads evident. The manager has set up weekly checks for the maintenance man which include hot water temperature checks and wheelchair checks. The records show that these checks are being kept up to date. Radiator covers have been fitted to all radiators. The manager has appointed additional cleaning staff, and the premises are much cleaner than previously. However, the decorative condition is generally so poor, that cleaning does not enhance it. For example, window sills and skirting boards are thick with old coats of paint which are chipped and scuffed, and cannot be cleaned effectively. We viewed twelve bedrooms at this visit, as well as communal areas. We were unable to view the other bedrooms as residents were receiving personal care or it was inappropriate to visit them (e.g. they were sleeping). Eleven of the twelve bedrooms viewed were in a poor decorative condition. This includes paintwork on the walls which is old and faded, and has dirty marks on it; and old and damaged wallpaper borders. We identified nine bedrooms which have dirty and stained carpets; and two of these are also dangerously frayed, posing a health and safety risk of tripping. Carpets in the corridors and hallways on both floors are dirty and stained; and the carpet in the conservatory is very worn and dirty. This is not a reflection on the cleaning staff who are working to keep the premises clean. The walls and carpets will no longer respond to cleaning processes. Much of the bedroom furniture viewed is old, and no longer of good quality. The armchairs and tables in the conservatory are unsuitable, as armchairs are sagging with old cushions; and tables are very scuffed and do not present a good appearance. We saw two over sink shelving units (one in a bedroom, and one in a bathroom), which are damaged and stained. The beds provided are old hospital beds or divans. The manager commenced a detailed individual risk assessment for each bedroom, but has not carried on with this, as there is so much work to be done in each bedroom. There is no evidence of any improvements to the rear garden area since the last key inspection. The patio has uneven paving slabs with weeds growing between them; and this is a trip and slip hazard. The garden furniture consists of old green plastic chairs and a table which are stained and dirty, and an old wooden bench which is dirty, and potentially unsafe to use. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 23 The front of the premises has been improved cosmetically with a flowerbed containing plants and flowers. However, the exterior of the building is not in a good state of repair, with damaged and dirty paint work. The windows themselves need cleaning, and one resident said “there used to be a window cleaner, but I have not seen him for a long time”. The home has two bathrooms which are not being used at present. One of these has a “Parker” bath, and the current residents do not like this type of bath. There are plans to alter this into a shower room. Another bathroom has a bath with an assisted bath, and a new part has been ordered for the hoisting facility which is rusty. The door to this bathroom is damaged and needs to be replaced. There is a third bathroom on the ground floor which is being used for fifteen residents. There are a sufficient number of toilets available. Some bedrooms have en-suite toilet facilities. These are too small to accommodate wheelchair users; and most have insufficient space for residents who need to use a walking frame. The laundry room is small but was seen to be clean and well organised. The providers have failed to meet requirements given at the last inspection as detailed: • to put an action plan in place for the ongoing refurbishment of the building, for internal and external decoration; • that poor quality furniture should be replaced as needed; • that frayed carpets should be replaced in accordance with the health and safety of residents and staff, and dirty carpets cleaned or replaced as appropriate. • that the providers must ensure that there are a sufficient number of bathrooms and showers which are suitable for residents’ use; and will take the equipment needed. • that the providers must ensure the safety of service users and staff by ensuring that all parts of the premises and equipment are clean and promote good infection control; • that outside areas are safe to use. We received an improvement plan completed by the registered provider dated 11th June 2009. This was poorly completed, as it did not specify the action to be taken for each requirement; and did not include any timescales for completion. A sentence at the end states (exact quotation) “All requirements from inspection of 15/16 of April 2009 has been thoroughly look at and appropriate actions taken”. An action plan was completed by the manager and received by us on 22nd June. This states “there is also the ongoing refurbishment of the home. These include new offices for manager, nurses and carers, new carpets in many rooms and the hallways and lounges, plan to redecorate and paint the front of St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 24 the house; the kitchen cupboard has been replaced, to pressure wash the back garden patio and purchase new garden furniture and start a gardening programme, including a sensory garden; the conservatory is to have new blinds fitted and an activities area to be set up with a residents and relatives notice board. A plan for all general refurbishment is in place. A regular review is done of all furniture, and no broken furniture is ever used. Carpets are being replaced and carpets are regularly cleansed.” There are no timescales included. The manager stated that she has consistently brought these matters to the attention of the providers; has had all bedrooms and hallways measured for new carpets, and has located suitable carpet shops. We asked the provider if there was a detailed plan of action for refurbishment (i.e. specifying exactly what is being done and when) and she said “yes”. However, when we later asked the manager for a copy of this she said she was not aware that this had been done. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers have been increased, and more staff training has been implemented. The staff work well together, and support the manager and each other. EVIDENCE: An immediate requirement was given at the last key inspection in regards to numbers of care staff for the afternoon, evening, and night shifts. We were informed that this requirement was met within the specified timescale, and confirmed this at our compliance visit on 2nd July 2009. Staffing rotas were very muddled, but it was possible to establish that staffing levels had been raised in response to the requirement. The care staffing levels have remained the same, and the rotas are now printed on a computer and are clear and easy to read. There are now five care staff for morning shifts; four care staff for the afternoons and evenings; and two care staff at night. This is in addition to a registered nurse on duty throughout the twenty-four hour period. Numbers of kitchen and domestic staff have also been increased, so that care staff are no longer being required to take part in kitchen and domestic duties. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 26 The home employs one full time nurse and several part-time nurses. The manager and one of the providers (who is a registered nurse) are also covering some of the nursing shifts. There is ongoing recruitment taking place for another full time nurse. The home has one or two care staff who have completed NVQ levels 2 or 3 training. The overall number is below 50 . Several care staff are hoping to carry out this training. The manager has implemented a new training programme in association with “Learn to Care”. A staff training matrix shows that staff have been updated with mandatory training, including moving and handling, infection control, basic food hygiene, fire safety and first aid. We viewed two staff recruitment files to check that staff recruitment processes continue to be well managed. The files include all required checks, such as proof of identity, POVA and CRB checks, two written references, and confirmation of previous training. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has worked hard to achieve improved performance in the home. The providers have failed to meet health and safety requirements. EVIDENCE: The manager was appointed on 8th June 2009. She is a registered nurse, who has previously been registered with the Commission as a manager for another home. She is experienced in caring for older people with nursing needs; and is studying for a degree in health and social care. She has not yet applied to the Commission to be the registered manager for this home. A letter was sent out St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 28 to the manager and to the provider during the same week as this inspection, reminding them in writing that it is an offence for a person to be in day to day control of a care home without being registered with the Commission. We also discussed this with them on the day of the visit, and they said that they would be making a decision as to their actions in this respect. A requirement is included in this report. The manager has implemented staff meetings, and staff reported that they feel more valued and aware that their views are important. They were seen to be supportive of each other and to work well together. Several spoke highly of the input they have received from the manager, and of the improvements she has made since her arrival. The manager has also implemented residents and relatives meetings, and she is proposing to have these meetings every two months. She has written to relatives to inform them of these meetings, and has also sent them a copy of the amended complaints procedure, and a quality assurance questionnaire. The completed forms are in the process of being returned. We viewed two of these, and they are very detailed questionnaires, providing the relatives with the opportunity to express their views anonymously. The completed forms which we viewed showed that relatives are mostly concerned about the state of the environment that the residents are living in. One expressed that they are “not at all satisfied” with the appearance of the front hall and reception area; and the other stated that they were “not at all satisfied” with the outside appearance of the gardens. Both had ticked that they were satisfied with the standards of care. One relative commented that “since the arrival of a new manager the situation is improving”. Residents are more able to express their views now that a manager is in post; and also talk easily with the activities co-ordinator, who feeds back their views to the manager. The manager reported to us that she has asked the providers for a copy of the home’s accounts, so that she can implement a budgeting system, which is within her remit to do; however the providers stated that these accounts are not yet available from the accountants. The registered person stated to us during the visit, her concern about implementing environmental improvements while the numbers of residents are restricted, and there is therefore less revenue coming in. We will be following up this inspection visit to assess financial viability of the business. Residents’ pocket monies are managed by the activities co-ordinator. These are small amounts of money which are stored in a safe place. Each person has an individual account, and all debits and credits are recorded. The co-ordinator checks the amounts at each transaction. It would be good practice for an independent person to check the accounts on a regular basis (e.g. monthly), to verify that no errors have been made. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 29 The manager has commenced one to one supervision sessions with staff, and is planning to carry these out every two months. We did not view the documentation at this visit. Staff are being trained in safe working practices; and accidents and incidents are properly recorded. St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 1 1 2 X 1 3 3 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 1 3 2 X 1 St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (3) Requirement The flooring in the clinical room must be replaced with flooring which can be cleaned on a daily basis or as needed, to promote good infection control. And a pedal bin should be supplied in the clinical room. The registered person must increase the number of hours available by activities staff, to enable residents to carry out their preferred activities. The registered person must provide suitable kitchen equipment to enable staff to provide hot drinks for residents at all times e.g. a hot water urn. The registered person must: Provide the Commission with a detailed action plan which includes timescales, for the refurbishment of the building; including internal and external decoration. The action plan must be sent to the Commission by the given date. The frayed carpets in bedrooms DS0000026118.V377977.R01.S.doc Timescale for action 30/11/09 2 OP12 16 (2) (m) 30/01/10 3 OP15 16 (2) (g) 30/11/09 4 OP19 23 (2) 30/11/09 5 OP19 13 (4) 30/11/09 Page 32 St Benedict`s Nursing Home Version 5.3 9 and 13 must be replaced by the given date, in accordance with the health and safety of residents and staff. 6 OP19 16 (2) (c) 13 (3) The registered person must: Provide the Commission with an action plan by the given date, with appropriate timescales, for carrying out the following items: • To replace the identified damaged units, which are above two wash hand basins. To ensure that furniture items are fit for purpose, replacing them as needed. This includes the tables and armchairs in the conservatory. To replace all other dirty and stained carpets (i.e. apart from bedrooms 9 and 13). This includes the ground and first floor landing and corridors; the lounge, dining room and conservatory; and bedrooms 1, 7, 8, 11, 17, 19, 20, 21,22 and 23. To assess all other bedrooms to ascertain if the carpets need to be replaced, and take action according to the findings. This must be included in the action plan. Timescales must be included. 30/11/09 30/11/09 • • • 7 OP21 23 (2) (j) The registered person must: Ensure that there are sufficient numbers of bathrooms or St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 33 showers in use to meet residents’ needs; and in regards to this, must provide the Commission with a detailed action plan which includes timescales for completion, showing how they propose to meet this requirement. 8 OP31 8, 9 and Care Standards Act 2000, Part II (11) (1) 23 (2) (o) A Registered Managers’ application for registration with the Commission must be made within three months of the inspection visit. 06/01/10 9 OP38 The registered person must 31/01/10 ensure the safety of service users and staff. External grounds must be suitable and safe for service users and staff to use, and must be appropriately maintained. This means that the patio area in the rear garden must be made safe; and unsafe or poor quality garden furniture must be repaired or replaced. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Benedict`s Nursing Home DS0000026118.V377977.R01.S.doc Version 5.3 Page 34 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southeast@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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